Poster Session 1
Category: Labor
Poster Session 1
Ina Ryvkin, MD (she/her/hers)
Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
Jerusalem, Yerushalayim, Israel
Efrat Shekel, MD
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel., Yerushalayim, Israel
Renana dimant, MD
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel., Yerushalayim, Israel
Tehilla Stamler-Yakobi, MD
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel., Yerushalayim, Israel
Snir Tamari, MD
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel, Yerushalayim, Israel
Naama Lessans, MD
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel, Yerushalayim, Israel
Doron Kabiri, MD, MPH (he/him/his)
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel., Yerushalayim, Israel
To assess the probability of successful vaginal delivery and identify determinants of delivery mode in nulliparous women aged ≥40 years carrying fetuses with birth weight ≥3750 grams.
Study Design:
Retrospective cohort study. From a cohort exceeding 250,000 deliveries between 2003 and 2025, 12,818 involved women aged ≥40 years. Of these, 76 were nulliparous with fetuses weighing ≥3750 grams. Thirty-seven women underwent planned cesarean delivery, while 39 attempted vaginal delivery. Outcomes were compared between women with successful vaginal delivery (n=19) and those requiring unplanned cesarean section (n=20). Variables analyzed included maternal age, prolonged second stage of labor, use of neuraxial anesthesia, fetal sex, and neonatal complications. Statistical analysis employed Mann-Whitney U test for continuous variables and Fisher's exact test or Chi-square test for categorical variables.
Results:
As shown in Figure 1 Spontaneous vaginal delivery occurred in 11 cases (28.2%), instrumental vaginal delivery in 8 cases (20.5%), and unplanned cesarean section in 20 cases (51.3%). The overall vaginal delivery success rate was 48.7% (19/39). The two groups were comparable in baseline characteristics (Table 1), with the only significant difference being the use of neuraxial anesthesia (p = 0.046), probably attributable to standard practice rather than a causal relationship. No definitive predictors of vaginal delivery success were identified. Neonatal outcomes were favorable in both groups, with low rates of NICU admission.
Conclusion:
In nulliparous women aged ≥40 years carrying fetuses with birth weight ≥3750 grams, the vaginal delivery success rate was 48.7%. These findings suggest that a trial of labor may be a reasonable option under careful intrapartum monitoring.